Discuss COPD Symptoms with Your Doctor

Use this questionnaire to record your specific COPD symptoms. Share your answers with your COPD treatment team. Only they can assess your COPD symptoms and determine if adjustments need to be made to your treatment. This information is provided for your education and is not a substitute for diagnosis by a healthcare professional. Ask your doctor, nurse or respiration therapist about your treatment options.

Please answer Yes or No to ALL questions.

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1. Do you have a hard time taking deep breaths?
2. Do you experience shortness of breath when active?
3. Are you using your rescue inhaler more often?
4. Do you wake up in the middle of the night to use your inhaler?
5. Do you have trouble getting the timing right with your inhaler?
6. Have your symptoms increased and/or changed over time?
7. Are you often short of breath?

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COPD Daily Diary

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Important Safety Information

People with asthma who take long-acting beta2 adrenergic agonist (LABA) medicines such as PERFOROMIST have an increased risk of death from asthma problems. It is not known whether LABA medicines, such as PERFOROMIST, increase the risk of death in people with COPD. Get emergency medical care if breathing problems worsen quickly, or you use your rescue inhaler medicine but it does not relieve your breathing problems

Indication

PERFOROMIST Inhalation Solution is used long term, twice a day (morning and evening), in controlling symptoms of chronic obstructive pulmonary disease (COPD) in adults with COPD. PERFOROMIST is for inhalation use only through a standard jet nebulizer connected to an air compressor and should not be swallowed or injected.

Important Safety Information

PERFOROMIST should not be used in children.

PERFOROMIST is not for use to treat sudden symptoms of COPD and should not be used more than twice a day. Always have a short-acting beta2-agonist with you to treat sudden symptoms.

Tell your healthcare professional about all of your health conditions, including if you:

  • have heart problems
  • have high blood pressure
  • have diabetes
  • have seizures
  • have thyroid problems
  • have liver problems
  • are pregnant or planning to become pregnant. It is not known if PERFOROMIST Inhalation Solution can harm an unborn baby.
  • are breastfeeding. It is not known if PERFOROMIST Inhalation Solution passes into breast milk and if it can harm your baby.

Tell your healthcare professional about all medicines you take including prescription and non-prescription medications, vitamins, and herbal supplements. PERFOROMIST and certain medicines may interact with each other and cause serious side effects.

PERFOROMIST can cause serious side effects including:

  • Increased risk of death from asthma problems (See Boxed Warning above)
  • Sudden shortness of breath immediately after use of PERFOROMIST
  • Serious allergic reactions including rash, hives, swelling of the face, mouth, and tongue, and breathing problems. Call your healthcare professional or get emergency medical care if you get any symptoms of a serious allergic reaction.
  • Chest pain
  • Increased or decreased blood pressure
  • A fast and irregular heartbeat
  • Low blood potassium
  • High blood sugar
  • High blood acid

The most common side effects of PERFOROMIST include:

  • Headache
  • Tremor
  • Nervousness
  • Dry mouth
  • Muscle cramps
  • Nausea, vomiting
  • Diarrhea
  • Dizziness
  • Trouble sleeping
  • If your COPD symptoms worsen over time do not increase your dose of PERFOROMIST, instead call your healthcare professional.

Click here for full Prescribing Information, including Boxed Warning and Medication Guide.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Prescribing Information Show More

Important Safety Information

People with asthma who take long-acting beta2 adrenergic agonist (LABA) medicines such as PERFOROMIST have an increased risk of death from asthma problems. It is not known whether LABA medicines, such as PERFOROMIST, increase the risk of death in people with COPD. Get emergency medical care if breathing problems worsen quickly, or you use your rescue inhaler medicine but it does not relieve your breathing problems

Indication

PERFOROMIST Inhalation Solution is used long term, twice a day (morning and evening), in controlling symptoms of chronic obstructive pulmonary disease (COPD) in adults with COPD. PERFOROMIST is for inhalation use only through a standard jet nebulizer connected to an air compressor and should not be swallowed or injected.

Important Safety Information

PERFOROMIST should not be used in children.

PERFOROMIST is not for use to treat sudden symptoms of COPD and should not be used more than twice a day. Always have a short-acting beta2-agonist with you to treat sudden symptoms.

Tell your healthcare professional about all of your health conditions, including if you:

  • have heart problems
  • have high blood pressure
  • have diabetes
  • have seizures
  • have thyroid problems
  • have liver problems
  • are pregnant or planning to become pregnant. It is not known if PERFOROMIST Inhalation Solution can harm an unborn baby.
  • are breastfeeding. It is not known if PERFOROMIST Inhalation Solution passes into breast milk and if it can harm your baby.

Tell your healthcare professional about all medicines you take including prescription and non-prescription medications, vitamins, and herbal supplements. PERFOROMIST and certain medicines may interact with each other and cause serious side effects.

PERFOROMIST can cause serious side effects including:

  • Increased risk of death from asthma problems (See Boxed Warning above)
  • Sudden shortness of breath immediately after use of PERFOROMIST
  • Serious allergic reactions including rash, hives, swelling of the face, mouth, and tongue, and breathing problems. Call your healthcare professional or get emergency medical care if you get any symptoms of a serious allergic reaction.
  • Chest pain
  • Increased or decreased blood pressure
  • A fast and irregular heartbeat
  • Low blood potassium
  • High blood sugar
  • High blood acid

The most common side effects of PERFOROMIST include:

  • Headache
  • Tremor
  • Nervousness
  • Dry mouth
  • Muscle cramps
  • Nausea, vomiting
  • Diarrhea
  • Dizziness
  • Trouble sleeping
  • If your COPD symptoms worsen over time do not increase your dose of PERFOROMIST, instead call your healthcare professional.

Click here for full Prescribing Information, including Boxed Warning and Medication Guide.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

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